It’s flu season again and this year patients have two viruses to worry about: COVID-19 and influenza. Now is the time patients will come in to get their flu vaccine and (hopefully) take the flu possibility out of the equation.
Vaccinations are usually billed with two CPT codes: one for the vaccine and one for the administration of the vaccine. If the practice did not pay for the vaccine, only the CPT code for the administration of the vaccine is reported. When the vaccines are supplied by a Vaccine for Children Program (VFC), how the administration of the vaccine is reported will vary by State Medicaid carrier.
There are several codes to report the actual vaccine. To determine the correct code, you need to know the manufacturer and the trade name.
Other items to share with your billing team are the dosage, age group, and National Drug Code (NDC) so the claims can be submitted correctly.
The administration is reported with HCPCS G0008, (Administration of influenza virus vaccine) for Medicare. For other payers, use CPT 90471 for an injection. If administration is by an intranasal or oral route, report CPT 90473. For pediatric patients, if injections include counseling for patients up to and including age 18, see CPT code 90460.
All vaccines are reported with diagnosis code Z23 (Encounter for immunization).
Avoid these Common Billing Errors
- Do not report CPT 96372 for administration of the vaccine. This code is used to report a diagnostic injection.
- If multiple vaccines are given on the same date, code for each administration. Use add-on codes to report these additional services: 90472, 90474, and 90461.
- When reporting administration codes 90460 and 90461, be sure to document counseling. Also, do not report for patients over 18 years of age.
- Report the correct NDC for each product purchased. This number is unique with segments that identify the labeler or vendor, product, and trade package. It could change during the season.
- If the type of product purchased changes, be sure to verify you are continuing to report the correct CPT code and the correct administration code, if it is performed via a different route.
The Centers for Disease Control and Prevention (CDC) indicates there is enough vaccine to go around. For more information, go to https://www.cdc.gov/flu/index.htm.